艾塞那肽对糖尿病合并肥胖患者心血管危险因素的影响机制研究  

Mechanism of Exenatide to Cardiovascular Risk Factors in Patients with Diabetes Combined with Obesity

作　　者：宋青青[1] 黄春[1] 李青[1] 周波[1] 黄云飞[1] 莫小庆 刘洁[1] 

机构地区：[1]广东医科大学附属湛江中心人民医院,广东湛江524037

出　　处：《中国医学创新》2017年第11期13-16,共4页Medical Innovation of China

摘　　要：目的:观察比较胰高血糖素样肽1(GLP-1)类似物艾塞那肽以及格列美脲干预治疗2型糖尿病合并肥胖患者血糖水平及心血管相关标志物水平变化探讨GLP-1心血管保护机制。方法:40例诊断2型糖尿病合并肥胖患者,近3个月使用二甲双胍单药治疗达1500 mg且血糖控制不佳的患者为研究对象,按照随机数字表法分为两组。艾塞那肽组采用艾塞那肽5μg,2次/d,皮下注射,1个月之后剂量增至10μg,2次/d,皮下注射;格列美脲组采用格列美脲2 mg,1次/d起始,根据患者的血糖情况适当调节格列美脲最高剂量至4 mg,1次/d。治疗24周后,观察两组体重、BMI、腰围、空腹血糖、餐后2 h血糖、血脂、糖化血红蛋白(Hb A1c)、Hcy、Lp-PLA2、HOMA-IR、HOMA-IS水平改变。结果:与治疗前相比,两组治疗后空腹、餐后2 h血糖及Hb A1c水平均显著降低(P<0.05),但两组比较差异均无统计学意义(P>0.05)。艾塞那肽组体重、BMI、腰围、血脂、Hcy、Lp-PLA2、HOMA-IR、HOMA-IS较治疗前均明显下降(P<0.05),而格列美脲组无明显变化。结论:艾塞那肽降糖效果与格列美脲相当,但其可通过有效降低体重、改善胰岛素抵抗并降低心血管相关危险因素水平,从而发挥心血管保护作用。Objective： To investigate cardiovascular protective mechanism of glucagon-]ike peptlde-1 by observing and comparing the levels of blood glucose and markers for cardiovascular disease in type 2 diabetes mellitus combined with obesity and the effect of glimepiride and exenatide on these markers.Method： This study included 40 obese T2DM patients had been treated with poorly controlled diabetes using Mefformin （ 1500 mg ） in the latest 3 months.The patients were randomly divided into Exenatide group and Glimepiride group. Subcutaneous injection of 5 Ix g Exenatide twice a day were applied to Exenatide group, dosage was increased to 10 tx g after 1 month.Initial dose of Glimepiride was 2 mg, once a day, according the situation of blood glucose in patients to appropriate adjusting the dose of Glimepiride to highest dose to 4 mg, once a day.The body mass index （BMI）, waistline, fasting blood-glucose, 2-hour post-meal blood glucose, lipids, HbAlc, HOMA- IR, HOMA-IS and the markers for cardiovascular disease including homocysteine （Hcy ） and lipoprotein- associated phospholipase A2 （ Lp-PLA2 ） were detected at 24 weeks after the patients being treated.Result： The levels of blood glucose and HbAlc decreased in both two groups after treatment, but there were no significant differences between two groups （P〉0.05） .The levels of BMI, waistline, blood lipid, Hey, Lp-PLA2 were dramatically reduced after administration of Exenatide group （ P〈0.05 ）, but Glimepiride group had no obvious changes.Conclusion： Exenatide has similar blood glucose lowering effect as Glimepiride, exenatide plays a role of cardiovascular protection by reducing levels of cardiovascular risk factors through reducing the body weight and improving insulin resistance.

关 键 词：胰高血糖素样肽1 2型糖尿病 肥胖 同型半胱氨酸 血浆磷脂酶A2 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]